Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication

Peters, Gesine; Winston, Joshua; Nuwayhid, Fadi; Pointon, Owen

doi:10.7759/cureus.24032

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…However, no studies have directly compared more invasive treatments with conservative treatment options 8. Our case suggests that conservative treatment with a Foley catheter and antibiotics can also be successful in managing this complication 6…”

Section: Discussionmentioning

confidence: 87%

“…Holmium laser enucleation of the prostate (HoLEP) has recently emerged as an efficacious alternative due to its shorter hospital stay and long-term durability 3. While generally safe, there have been several documented cases of osteitis pubis as a rare complication following TURP 4–6. In this case study, we detail the first reported occurrence of osteitis pubis following HoLEP.…”

Section: Introductionmentioning

confidence: 95%

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Osteitis pubis following holmium laser enucleation of the prostate

Smani,

Reddy,

Kong

et al. 2023

BMJ Case Rep

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Osteitis pubis is a rare, inflammatory condition involving the pubic symphysis. While osteitis pubis has been reported following many urological procedures, including those addressing bladder outlet obstruction such as transurethral resection of the prostate, it has never been reported after holmium laser enucleation of the prostate (HoLEP). Here, we detail the clinical course of a patient found to have osteitis pubis following HoLEP. This patient presented several weeks after surgery with non-specific, persistent symptoms of groin pain and difficulty ambulating, alerting our clinicians to consider osteitis pubis which was confirmed on MRI of the pelvis. While the majority of osteitis pubis cases are managed with locally invasive techniques, our patient’s symptoms were successfully managed conservatively with Foley catheter placement, oral antibiotics and close follow-up. At 9 months postoperative, the patient has reported complete resolution of symptoms and continues to be followed closely.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 95%

Osteitis pubis following holmium laser enucleation of the prostate

Smani,

Reddy,

Kong

et al. 2023

BMJ Case Rep

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“…USF in an irradiated tissue usually fails conservative treatment. Nonetheless, heterogenous treatment options from conservative management [1] to extensive surgery with pubectomy and urinary reconstruction as a treatment standard [2] have been proposed. Nonetheless, there is a knowledge gap in the current literature on the optimal management of USF.…”

Section: Introductionmentioning

confidence: 99%

Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

Brändstedt

Abrahamsson

Baseckas

et al. 2023

SJU

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Objective: To report population-based clinical presentation and outcomes in patients with urosymphyseal fistula (USF) after pelvic radiotherapy (RT).Patients and methods: A retrospective chart review was performed in 33 consecutive patients diagnosed with suspicion of USF in a tertial referral center from 2014–2022 to ascertain information about diagnostic delay, clinical presentation, precipitating causes, treatments received and outcomes during the median 22 months follow-up. Out of 33 consecutive patients with suspicion of USF, one female with vesicovaginal fistula, one patient developing RT-associated bladder angiosarcoma, four patients with short follow-up (<3 months), and three patients that during chart review not were considered to have a USF were excluded. Results: In all, 24 males with a median age of 77 years were diagnosed with USF. Local pain was the predominating symptom in 17/24 (71%) patients. Endourologic manipulations preceded the diagnosis of USF in 16 patients. Five patients had a diagnostic delay of more than 3 months. At diagnosis, 20/24 patients had radiological signs of osteomyelitis, and five had a concomitant rectourethral fistula. Due to comorbidity, five patients were not amenable to any other interventions than urinary catheter or suprapubic tube in conjunction with long-term antibiotics, of which three died from infections related to the USF. Out of the remaining 19 patients receiving some form of urinary diversion, five had recurrent osteomyelitis, of which four did not undergo cystectomy in conjunction with surgery for the USF.Conclusions: Urethral endourologic interventions in patients previously subjected to pelvic RT should be performed cautiously.

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Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication

Cited by 2 publications

References 6 publications

Osteitis pubis following holmium laser enucleation of the prostate

Osteitis pubis following holmium laser enucleation of the prostate

Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

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